Abstract
To evaluate the cost-effectiveness of intravitreal aflibercept 2 mg every 8 weeks after 3 initial monthly doses (IVT-AFL 3+Q8) versus Ranibizumab 0.5 mg monthly (RAN Q4) and pro re nata after 3 initial monthly doses (RAN 3+PRN) in the treatment of patients with Neovascular Age-related Macular Degeneration (nAMD) from a Chinese payer’s perspective, so as to provide evidence to support rational drug use in clinical practice in China. A Markov model was developed to simulate the progression of the disease in terms of visual acuity. The model included health status of “no visual impairment”, “mild visual impairment”, “moderate visual impairment”, “severe vision loss”, “blindness”, and “death”. Transition probabilities and utility scores were derived from published literature. Cost data were collected from medical institutions and physician surveys. Costs and QALYs were discounted at 5.0% per year. One-way sensitivity analyses were conducted. For the lifetime horizon, the costs of IVT-AFL 3+Q8, RAN Q4 and RAN 3+PRN were 129,676.18 CNY, 164,903.36 CNY and 135,912.20 CNY respectively. The corresponding quality-adjusted life years (QALYs) were 6.162 QALYs, 6.162 QALYs and 6.156 QALYs. IVT-AFL 3+Q8 was dominant vs. RAN Q4 vs. RAN 3+PRN groups since it was cost saving (same outcome 6.162 QALYs with less costs). Sensitivity analyses showed that this result was robust. IVT-AFL 3+Q8 was similarly or more effective in terms of QALYs and less costly compared with RAN Q4 and RAN 3+PRN for nAMD patients in China.
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